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“A Costco-sized bottle of TUMS” was a gift I once requested for my 31st birthday. I wasn’t kidding; I’d been consuming the chalky tablets three to four times a day for over a year, and I needed to restock my supply.
I never feared getting older like my friends did, mostly because the deteriorating health issues they complained about in their 20s hadn’t hit me yet. All I had to manage was depression and anxiety, which I’d been diagnosed with at 14, and I’d take that over a bad back or knee pain any day.
I felt completely fine on my last day as a 29-year-old, but when I woke up with terrible heartburn on my 30th birthday, it wasn’t a one-time case of over-indulging on birthday cake and alcohol. It was the start of a new era of gastrointestinal issues my mind and body was not prepared for.
Experts In This Article
- Ernesto Lira de la Rosa, PhD, clinical psychologist with Columbia Health
- Roshini Raj, MD, board-certified gastroenterologist, associate professor of medicine at the NYU Grossman School of Medicine, author of Gut Renovation, and co-founder of YayDay digestive supplements
“GERD It Is”
A few months after my symptoms started—which included daily heartburn, acid reflux (especially at night), belching, and bloating—I decided it was time to see a professional. “You likely have gastroesophageal reflux disease, better known as GERD,” my gastroenterologist explained. She recommended I undergo an endoscopy to diagnose it for sure.
“Which end does the endoscope go in?” I asked nervously.
My doctor laughed. “It goes into your mouth, and down your esophagus,” she explained. “And you’re under anesthesia the entire time, so you won’t feel anything either. You won’t be awake at all.”
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The process took less than two hours, with the actual endoscopy part lasting less than 15 minutes. It felt like I’d been asleep for days. When I was more coherent, my doctor showed me images of the results.
“GERD it is,” she said, showing me how my insides were luckily ulcer- and cancer-free, but that there was definitely a buildup of acid causing my discomfort, along with a hiatal hernia. This kind of hernia, common in people living with GERD, occurs when part of your stomach pushes up through your diaphragm. Your diaphragm is normally the transition point between your esophagus and stomach, so this can push stomach acid into the esophagus, causing reflux.
I was ready to accept what my doctor described to be a “completely manageable condition” that was most easily relieved through diet changes and exercise. But I was wholly unprepared for the effect it would have on my mental health, and how it would exacerbate the feelings of anxiety and depression I had been living with for decades.
Learning about my diagnosis
While my diagnosis felt personal and isolating, GERD is a very common gastrointestinal condition. According to Yale Medicine, GERD affects approximately 20 percent of people in the U.S., and family history may play a role in who’s more likely to get it.
My dad and brother seemed to suffer from the same symptoms I had, which included persistent, daily heartburn and a sour fluid that bubbled up and woke me up in the middle of the night (which I’d later find out was acid).
“We normally have hydrochloric acid in our stomach to kick off the digestion process. When there’s too much acid, though, it can rise up into the esophagus—the tube that connects your throat to your stomach—and cause painful heartburn and inflammation,” says Roshini Raj, MD, a board-certified gastroenterologist, associate professor of medicine at the NYU Grossman School of Medicine, author of Gut Renovation, and co-founder of YayDay digestive supplements.
“Acid reflux happens if the lower esophageal sphincter (LES) loosens or relaxes and lets stomach acid travel upward into the esophagus,” she continues. It’s as unpleasant as it sounds, but it can also “irritate the esophagus so much that it gets inflamed, swollen, or even ulcerated” leading to trouble swallowing and even changes that can lead to cancer.
Pregnant people, those with overweight or obesity, smokers, and people with a hiatal hernia are all at increased risk for GERD, she explains, and an endoscopy or X-rays can be used to fully determine the diagnosis.
After my endoscopy, my doctor suggested a two-week trial of medications to see if they helped tame my symptoms, which included a proton pump inhibitor called omeprazole to help reduce the stomach’s production of acid, antacid tablets to neutralize stomach acid, and probiotics to support my gut health. The medicines provided some relief, but it was clear I also needed to make some major life changes.
Most importantly, I had to make some big changes to my diet—and that came with some surprising side effects on my mental health.
I knew I had to cut back on pizza to manage my GERD symptoms, but not making my Italian grandmother’s sauce recipe every Sunday? That was extremely challenging.
How managing GERD triggered my depression and anxiety
Food has always been much more than sustenance to me. Over the years, I’ve turned to cooking and comfort foods as a way to help manage my depression and anxiety.
Choosing a recipe, planning and buying ingredients, taking my time to put the meal together, and enjoying the result of my work helps me feel structured and in control. I’d purposely choose elaborate dishes with complicated steps to prolong the process; the longer it took to make something, the longer I was distracted from my mental health challenges.
I especially loved cooking my Italian grandmother’s recipes. She was an amazing cook, and she understood the transformative power a shared meal could have. Whether it was pastina to help soothe me when I was sick, fresh mozzarella from the Italian deli as a snack after school, or a homemade ricotta cheesecake for my birthday, I knew whatever we ate together would make any bad feelings I had disappear.
After she died, I found a box of her handwritten recipes and tried to make as many of them as possible. Being Italian, however, meant cooking with loads of GERD-stimulating ingredients: garlic, onions, tomatoes, chilis, and lemon. I knew I had to cut back on pizza to manage my GERD symptoms, but not making her sauce recipe every Sunday? That was extremely challenging.
I also had to give up many of the comfort foods I loved, including fast foods, ultra-processed foods (like Cheetos and Oreos), cheese, and overly fatty or fried foods, all of which are GERD triggers (and all of which I had been eating regularly before my diagnosis).
Finally, Dr. Raj notes that it’s recommended to avoid caffeinated beverages when you have GERD, so my daily cups of coffee had to come to a halt.
The connection between GERD and mental health
Because food was such a big part of my self-care, I didn’t realize how much my GERD would affect my mental health. The connection between my mind and my stomach had never been so apparent, but Ernesto Lira de la Rosa, PhD, a licensed clinical psychologist and media advisor for the Hope for Depression Research Foundation, says the link is much stronger than I realized.
“Any physical or medical condition can take a toll on someone’s mental health, especially if it causes discomfort,” he says, adding that some people “may experience anxiety and depression as they adjust to new lifestyle changes.”
Lira de la Rosa points to a 2019 study that examined the mental health effects of GERD in 258 people. “In particular, the study found that 70 of the participants reported both symptoms of anxiety and depression,” he says. Separately, nearly half had depression and more than a third had anxiety. More research is currently being explored to better understand the mind-gut connection, he adds.
“For conditions like GERD, individuals may feel anxious about what they can and cannot eat or perhaps feel disillusioned with the type of treatments for their condition,” he says. This was especially true in my case.
I obsessed over reading ingredient lists at the grocery store, to ensure what I bought wouldn’t exacerbate the condition. Going out to eat was a nightmare—garlic and onions are part of nearly every meal, and a ban on pizza, soda, and wine meant fewer dinner dates with friends and loved ones. I’d get anxious about what I could eat or drink at parties and big events (like weddings), where even the vegetarian dishes almost always contained GERD-triggering tomato sauce. Often, I’d end up with a dry salad, sans dressing or other toppings.
It was common for me to just not eat if the meal preparation was not in my control. Cooking became less creative and more of a means to sustain myself, which took out so much of the joy. I became anxious that I wasn’t eating enough or eating the right things, and then depressed because what I was eating wasn’t satisfying enough.
On particularly stressful days, I resorted to the opposite action—stuffing myself with whatever I could fit in my mouth, usually ultra-processed foods and fast food items. My depression would cause me to binge eat for a sense of comfort, but it always backfired. My GERD would come back with a vengeance, and I’d feel worse than before, both physically and mentally.
By avoiding certain foods to manage my GERD, I was feeling disconnected from my hobbies and my heritage, and I felt like I was compromising a very important part of who I am.
Striking a balance
I knew I had to find healthy ways to treat my GERD and mental health conditions.
Meal kits like Home Chef became a big help because I could choose the recipes, look at ingredients online, and not deal with the anxiety I once had choosing items in the grocery store.
I also began to spread out my dining times by eating several smaller meals instead of three large ones. And I experimented with low-acid foods like oatmeal, rice, spinach, and berries, and started following some Instagram accounts like The GERD Chef for support and inspiration.
Still, I didn’t think I could discuss my GERD-related anxieties with my therapist, because it didn’t make sense to me at first. We had been working on other issues related to my career and relationship—what did not eating tomatoes have to do with that? But I’m glad I did, because she was able to help provide useful strategies to manage it all.
First, she asked me to write out my emotions and read them to her every week. It felt hard to verbalize what I was feeling, but once I put the words on paper, the connections became much clearer. By avoiding certain foods to manage my GERD, I was feeling guilty and disconnected from my hobbies and my heritage, and I felt like I was compromising a very important part of who I am.
Next, my therapist asked me to keep a food diary. “Write down not only the meals you eat, but the ingredients in them as well,” she suggested. “Right down to the seasonings and spices.” I also had to write down any moments of discomfort and the times they occurred.
From this, I was able to track my eating habits and notice when any of them triggered my GERD. I analyzed my patterns and built a new list of favorite recipes and ingredients so I didn’t feel anxious when it came to meal planning or dining out.
My therapist made a point that I shouldn’t feel guilty about having non-GERD-friendly foods every now and then. I might not be able to make bacon, coffee, or chocolate cake the stars of my meal planning, but if I wanted to have some every now and again, that was okay—and I should shift my focus to be on all the healthy progress I’ve made so far instead of sitting with guilty feelings.
Finally, she asked me to ensure I kept in contact with my gastroenterologist and scheduled biannual check-ups until I felt like I was in control. Getting answers and advice straight from a GI doctor is much safer than doing search engine deep-dives, she explained.
Lira de la Rosa also recommends seeking out positive social connections to help manage food-related mental health conditions.
“You can search for virtual or in-person support groups for others who are working with food-related anxiety as a way to connect with others who may be going through something similar,” he says.
It’s been six years since my GERD diagnosis, and while I still struggle some days, I’ve gotten to a point where I feel more in control of my food choices, and they no longer affect my mental wellness. I’ve even figured out healthy modifications for my grandmother’s recipes, so I can continue enjoying the art of cooking she inspired in me.
Now I understand how important it is to connect my mental health with my gut health, and that through support and information from my doctors, I can still lead a happy and delicious life.
—medically reviewed by Jennifer Logan, MD, MPH
Well+Good articles reference scientific, reliable, recent, robust studies to back up the information we share. You can trust us along your wellness journey.
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Mohammad S, Chandio B, Soomro AA, Lakho S, Ali Z, Ali Soomro Z, Shaukat F. Depression and Anxiety in Patients with Gastroesophageal Reflux Disorder With and Without Chest Pain. Cureus. 2019 Nov 8;11(11):e6103. doi: 10.7759/cureus.6103. Erratum in: Cureus. 2019 Dec 10;11(12):c25. PMID: 31763106; PMCID: PMC6858267.
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